Hospital Report 2001 - An Update
The Hospital
Report 2001 Series builds on earlier hospital balanced scorecards developed by
researchers in the Department of Health Administration. In addition to the hospital
specific acute care balanced scorecards, this year’s work includes system-level
balanced scorecards for complex continuing care and emergency department care, feasibility
studies on rehabilitation, mental health, and population health, and special reports on
nursing care and women’s health. This range of reports reflects the development cycle
within the Hospital Report project.
Components of the
project evolve through three stages. Initially
a feasibility study evaluates the applicability of the balanced scorecard to a particular
health care sector and the feasibility of identifying indicators and collecting relevant
data. The next phase is a system-level balanced scorecard that includes the calculation of
indicators of clinical utilization and outcomes, patient satisfaction, financial condition
and performance, and system change and integration across hospital regions and hospital
peer groups. Investigators use system level reports to refine methodologies before
publishing data at a hospital-specific level. In
the third phase, researchers refine the risk-adjustment methods and indicator definitions
and publish hospital-specific results. This focus on risk adjustment in the third phase
helps to ensure comparisons between hospitals that are as fair as possible. Following the
release of acute care hospital results in Hospital Report ’99, researchers
from within the Department and the Canadian Institute of Health Information have worked
together to further refine these methods. CIHI
will release this year’s acute care hospital report on July 16, 2001. The remaining reports will be available in
November and December.
In contrast to
work on the sector specific reports, work this year on nursing care and women’s
health will be integrated into future reports to provide a more appropriate and more
comprehensive picture of hospital and health system performance. Despite the diversity of
work, however, researchers on the project follow a common approach and set of principles.
Following a review of the state of the science through literature searches, structured
interviews, site visits, and consultation with individual experts, the researchers convene
expert panels composed of clinicians, administrators, and health records professionals to
help select indicators. This approach has
helped to ensure a majority of hospitals participating in the project, despite the fact
that participation remains voluntary and requires hospitals to fund patient satisfaction
surveys and respond to a barrage of organizational questionnaires on practices, resources,
and other issues. Finally, to ensure that reports are useful for both quality improvement
and accountability, all methods used in the reports must be made publicly available.
This year’s
work also includes methodological research to support future reports. This research includes enhanced models for risk
adjustment, indices to aggregate individual performance measures, more work on the
relationship between hospital-level performance in different quadrants (e.g. patient
satisfaction and clinical utilization and outcomes), and the development of a resource
inventory for hospitals. Several researchers
are collaborating on a chart audit to assess the validity of many of the clinical outcomes
in the reports and on a survey sent to all acute hospital health records departments to
learn more about variations in coding quality. These efforts are the first steps in a
larger initiative to address issues of data quality.
Finally, researchers are also working on the development of episodes of care
that incorporate care provided in different sectors and by different institutions. This work should improve the measurement and
appropriate allocation of performance scores to organizations across the continuum of
care.
In addition to its
increased research activity, the project has also expanded from an organizational
perspective. In addition to faculty from the Department of Health Administration, the
project includes investigators from Department of Public Health Sciences, the
Rehabilitation Sciences Sector, the Faculty of Nursing, Providence Centre, the Centre for
Addiction and Mental Health, the University Health Research Network, and the Institute for
Clinical Evaluative Sciences in Ontario (ICES). The
Ministry of Health and Long-term Care joined the Ontario Hospital Association to jointly
sponsor the project. Representatives from
each sponsor organization along with hospital executives and other stakeholders provide
input to the project through advisory committees and numerous expert panels.
As
research progresses on all fronts, the new research collaborative has begun planning for
the future. Individual investigators have
proposed a variety of new sectors, new themes, and methodological innovations to increase
the breadth, depth, and sophistication of the Hospital Reports. These areas for expansion
include, most notably, ambulatory care, home care, the development of benchmarks, and
strong attention to improving the quality of data underlying the Reports and to measuring
employee and physician satisfaction. |
